- Datavant (Austin, TX)
- …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well...table:** + Two (2) years managed care experience in UM /CM/CDI Department preferred + Knowledge of CMS, State Regulations,… more
- UTMB Health (Webster, TX)
- …testing is also required. **_REQUIRED EDUCATION/EXPERIENCE_** **:** + Current Texas licensure as a Registered Nurse ( RN ).with a minimum of three (3) years ... AS 400. + Demonstrates skill in accurately entering required UM data. + Monitors and facilitates appropriate utilization of...transfers and admissions from the prison facility. + Conducts nurse to nurse conference calls for all… more
- San Antonio Behavioral Health (San Antonio, TX)
- …May consult with staff as needed. Essential Duties: + Collaborate and set standards with registered nurse ( RN ) case managers (CMs) and outcome managers to ... indicated. + Identify and facilitate resolution of system process problems impeding UM functions. Identify and resolve delays and obstacles as appropriate. +… more
- Evolent (Austin, TX)
- …mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Cardiology is responsible for support and assistance ... P2P discussions with one of the cardiologists. Responsible for coordinating with UM staff to ensure timely and accurate communication of clinical decisions.… more
- CVS Health (Austin, TX)
- …and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): + ... each and every day. **Position Summary** This Utilization Management ( UM ) Nurse Consultant role is 100% remote...sit for long periods of time. **Required Qualifications** + RN with active and unrestricted state licensure in their… more
- CVS Health (Austin, TX)
- …audit experience. + Experience in medical management, including Utilization Management ( UM ) and Case Management (CM). + Strong understanding of healthcare quality, ... accreditation processes, and NCQA standards. + Licensed clinical professional ( RN preferred). + Excellent analytical, organizational, and communication skills. +… more
- Highmark Health (Austin, TX)
- …experience + 1 year in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced training and experience in cognitive behavioral ... in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or...or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the… more
- Elevance Health (Grand Prairie, TX)
- …necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... provide an equivalent background. + Current active unrestricted license, such as ** RN LCSW** **LMSW LMHC** **LPC** (as allowed by applicable state laws) **LMFT**… more